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CLOSTRIDIUM DIFFICILE INFECTION

Clostridium difficile is a bacterium which lives in people’s intestines and also in the environment.  It is a part of a normal balance of the bacterium living in the intestines, but may sometimes begin to grow out of control and release toxins that attack the intestinal lining. This is called C.difficile infection. Prolonged use of antibiotics also causes C.difficile infection. If it is left untreated, it may lead to inflammation of the colon, a condition called colitis.

Signs and symptoms

The signs and symptoms of C.difficile infection develop within 5 to 10 days after starting the use of antibiotics. Watery diarrhea, for nearly 10 to 15 times a day, along with abdominal pain is the most common symptom. In severe conditions, diarrhea would be associated with blood. Other symptoms include:

  • Fever
  • Nausea
  • Loss of appetite
  • Dehydration
  • Weight loss
  • Kidney failure
  • Increased white blood cell count

Few people experience loose stools soon after starting antibiotic therapy. This is a common condition, but if it persists for the longer duration or if there is blood in the stool, meet the doctor.

Causes

The C.difficile bacterium is found everywhere in the environment- in the soil, water, human feces, and food products. Healthy people naturally have the bacterium in their intestine and don’t have ill effects. The bacterium is spread in the hospitals, nursing homes, and if the workers in the hospital contact with it and then with the patient, they may get C.difficile infection.

Long-term use of antibiotics kills useful bacteria along with the harmful bacteria. Due to this, C.difficile grows without control and release toxins that destroy cells and decay cellular debris inside the colon, causing watery diarrhea. Few examples of the antibiotics causing C.difficile infection include fluoroquinolones, cephalosporins, penicillins, and clindamycin.

Risk factors

Many people, including children, are at increased risk of C.difficile infection due to following factors:

  • Long-term use of antibiotics
  • Being 65 years of age or older
  • Taking other medications to reduce stomach acids, including proton pump inhibitors
  • Staying in a health care facility where germs spread easily
  • Having a serious illness such as inflammatory bowel disease or colorectal cancer
  • If the patient has undergone abdominal surgery or a gastrointestinal procedure

Complications

If the C.difficile infection is not treated effectively, the patient may develop certain complications like dehydration, kidney failure, toxic megacolon (the inability of the colon to expel gasses and stool), perforation in the large intestine, and may also lead to death.

Diagnosis

C.difficile infection is very difficult to diagnose as the symptoms are similar to the other intestinal diseases. Therefore, apart from physical examination and assessment of medical history, the doctor recommends undergoing the following tests:

  • Stool tests- a sample of stool is taken to detect the presence of C.difficile bacteria. The various lab tests used are enzyme immunoassay, polymerase chain reaction, glutamate dehydrogenase test, and cell cytotoxic assay.
  • Colon examination- this test is majorly used to confirm the diagnosis. A flexible tube is inserted into the colon to check for the areas of inflammation or pseudo membranes, this test is called colonoscopy or sigmoidoscopy.
  • Imaging tests- An abdominal X-ray or CT scan provides various images of the colon which helps to detect the presence of complications like thickening of the colon wall or hole in the lining of the colon.

Treatment

The doctor would first recommend stopping the use of antibiotics which is a major cause. Nearly 25% of people improve within 2 to 3 days of stopping the intake of antibiotics. In more severe conditions, these treatment options are considered.

  • Antibiotics- the doctor prescribes the use of 10-day course of antibiotics such as metronidazole or vancomycin. The patient usually improves after 72 hours of starting the medicine.
  • Surgery- this treatment option is considered when the patient has severe pain, toxic megacolon, inflammation of the lining of the abdominal wall; the diseased portion of the colon is removed.
  • Probiotics- these are healthy bacteria and yeast to that help restore a healthy balance of the bacteria. A yeast called Saccharomyces boulardii, along with antibiotics help to prevent the recurrence of C.difficile infection.

Prevention and self-management

The supportive treatment of C.difficile infection includes:

  • Drinking plenty of fluids
  • Patients with watery diarrhea should take starchy foods like potatoes, noodles, rice, wheat, and oatmeal.
  • Washing hands with soap and water after using a toilet and before eating
  • Health care professionals should wash the hands with alcohol-based sanitizers after caring the patients
  • Avoiding unnecessary use of antibiotics

 

 

 

 

 

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